Ultrasound positioning device, system, and method

ABSTRACT

Systems and methods can include a system for positioning an ultrasound probe proximal to anatomy of a patient on a radiation couch including a substantially planar base including engagement features to directly or indirectly index the substantially planar base to the radiation couch and a centrally located guide extending longitudinally along a top side of the base, a probe holder, configured to be coupled to, to translate longitudinally, and to be user-accessed and user-controlled from within, a central region of the substantially planar base, a clamp, configured to localize the probe holder at a specified location along a translation path in the central region of the substantially planar base, leg supports shaped to accommodate a patient&#39;s legs from behind, the pair of leg supports being shaped and arranged to provide a space therebetween that can accommodate an ultrasound probe holder.

CLAIM OF PRIORITY

This patent application claims the benefit of priority of U.S.Provisional Patent Application Ser. No. 62/623,463, filed on Jan. 29,2018, naming Francois Marcil as inventor, and entitled ULTRASOUNDPOSITIONING DEVICE, which is hereby incorporated by reference herein inits entirety.

TECHNICAL FIELD

Embodiments of the present subject matter pertain generally to a systemfor positioning an ultrasound device proximal to an anatomy of apatient.

OVERVIEW

Radiotherapy is used to treat cancers and other ailments in mammalian(e.g., human and animal) tissue. An example of radiotherapy is providedusing a linear accelerator (LINAC), by which a target (e.g., a tumor) isirradiated by high-energy particles in a radiation beam (e.g.,electrons, photons, ions, or the like). In an example of LINAC-basedradiation treatment, multiple radiation beams are directed toward thetarget from different angles. The placement and dose of the radiationbeam should be accurately controlled to ensure that the tumor receivesthe prescribed radiation, and the placement of the beam should be suchas to minimize damage to the surrounding healthy tissue, which can becalled the organ(s) at risk (OARs).

To prevent OARs from the severe collateral damage that can be caused bythe radiation beams, the doses received by these OARs should be limitedto a certain level. Such limitations on the doses received by the OARs,sometimes called constraints, need to be satisfied during radiationtreatment planning.

Treatment planning is a process involving determination of one or morespecific radiotherapy parameters (e.g., radiation beam angles, radiationintensity level at each angle, etc.) for implementing a treatment goalunder the constraints. A typical treatment planning process includesdelineating one or more targets and one or more OARs from a medicalimage of the patient, specifying radiation beam angles, or a range ofangles in the case of an arc plan, and determining an aperture shape orshapes and radiation intensity levels for each shape at each beam angle.Ultrasound imaging is one type of medical imaging that can be usedduring treatment planning (e.g., 2D ultrasound, 3D ultrasound, 4Dultrasound). The ultrasound imaging can also be used during theradiation treatment such as to determine in real time if targets or OARshave moved.

In certain radiation treatment systems, a patient can be positioned on aradiation couch and an ultrasound probe can be positioned proximal toanatomy of a patient, such as to acquire ultrasound images of thepatient anatomy for treatment planning or during the radiation treatmentof the patient.

The inventors have recognized, among other things, that the process ofpositioning an ultrasound probe can be greatly improved by providing aradiation treatment system in which the ultrasound probe can be indexedto a radiation couch and additionally can be centrally accessed andpositioned while a patient is on the radiation couch.

In an aspect, the disclosure can feature an overlay for providing amovable interface between an ultrasound probe holder and a couch forradiotherapy. The overlay can include a substantially planar baseincluding a top side. The overlay can also include a centrally locatedelongated guide extending longitudinally along the top side of the base,such as to guide translational movement of the ultrasound probe holderalong a longitudinal axis of the overlay. The elongated guide caninclude a longitudinal groove arranged to guide the ultrasound probeholder during translational movement along the longitudinal axis of theoverlay. The elongated guide can include a pair of rails includingrespective longitudinal grooves centrally facing each other and arrangedto guide the ultrasound probe holder during translational movement alonga longitudinal axis of the overlay. The elongated guide can include apair of rails including respective longitudinal grooves, outwardlyfacing away from each other and arranged, such as to engage at least onepatient support cushion. The overlay can also include indexed engagementfeatures that can engage directly or indirectly with the couch, a handlelocated at a first inferior end of the base of the overlay, and one ormore glides located on a bottom side of the base at an opposing secondsuperior end of the base of the overlay. The indexed engagement featurescan be arranged to engage with an indexing bar that engages with thecouch. A first inferior end of the elongated guide can include aunidirectional entry and capture member, such as to allow entry andengagement of a portion of the probe holder into the groove and toinhibit exit from the groove without user-disengagement of theunidirectional entry and capture member, and wherein a second superiorend of the elongated guide can include a stop to prevent exit of theprobe holder from the groove. The base can include leg support baseregions extending in laterally opposing directions from the centrallylocated elongated guide, the leg support base regions configured toprovide indexed longitudinal and lateral placement of respective kneesupport cushions and to provide adjustable longitudinal placement ofrespective foot support cushions. A pair of outwardly facinglongitudinal grooves can be configured to provide the adjustablelongitudinal placement of the respective foot cushions. The overlay canalso include a plurality of apertures at the second superior end of thebase, the pair of apertures configured, such as to provide a handle forproviding coarse positioning of the base with respect to the couch.

In an aspect, the disclosure can feature an overlay for providing amovable indexed adjustable interface between a subject and a radiationcouch. The overlay can include a substantially planar base including atop side and a bottom side. The overlay can also include a handlelocated on a top side at an inferior longitudinal end of the base. Theoverlay can also include one or more glides located on a bottom side atan opposing superior longitudinal end of the base. The overlay can alsoinclude indexed engagement features, such as to engage directly orindirectly with the radiation couch. The indexed engagement features canbe arranged to engage with an indexing bar that engages with theradiation couch. The one or more glides can include a first set ofglides located on the bottom side at the inferior longitudinal end ofthe base, the first set of glides being configured to provide resistanceto movement of the base along a longitudinal direction and a second setof longitudinal glides located on bottom of the superior longitudinalend of the base, the second set of glides being configured to permitmovement of the base along the longitudinal direction.

In an aspect, the disclosure can feature a method of using an overlay toindex a position of an ultrasound probe holder to a radiation couch, theoverlay including a substantially planar base including a top side, andincluding a centrally located elongated guide extending longitudinallyalong the top side of the base to guide translational movement of theultrasound probe holder along a longitudinal axis of the overlay. Themethod can include positioning the overlay at an indexed position on aradiation couch. The method can also include guiding translationalmovement of the ultrasound probe holder along a longitudinal axis of theoverlay from within a central region of the overlay. The method can alsoinclude guiding translational movement of the ultrasound probe holderfrom within the central region of the overlay using a longitudinalgroove along the longitudinal axis of the overlay. The method can alsoinclude guiding translational movement of the ultrasound probe holderfrom within the central region of the overlay using a pair of railsincluding respective longitudinal grooves centrally facing each otheralong a longitudinal axis of the overlay. The method can also includeengaging at least one patient support cushion using respectivelongitudinal grooves, outwardly facing away from each other. The methodcan also include positioning the overlay without engaging indexedengagement features using a handle located at a first inferior end ofthe base of the overlay, and one or more glides, located on a bottomside of the base at an opposing superior second end of the base of theoverlay; and then placing the overlay into engagement with one or moreof the indexed engagement features. Providing indexed engagement to aradiation couch can include using an indexing bar that engages with theradiation couch and with the overlay.

In an aspect, the disclosure can feature a probe holder for positioningan ultrasound probe. The probe holder can include a probe holder body,configured to be coupled to, to translate longitudinally within, and tobe user-accessed and user-controlled from within, a central region of aradiation couch or overlay thereupon, the central region being locatedbetween lateral regions that are arranged to be underlying a subject'slegs. The probe holder can also include a clamp, configured to localizethe probe holder at a specified location along a translation path in thecentral region. The probe holder can also include a rotatably-actuatedclamp located within a central portion of the probe holder body, theclamp being configured to increase a frictional force between the probeholder body and the overlay to localize the probe holder at a specifiedlocation along a translation path in the central region. The probeholder can also include transversely outwardly facing protrusionsaligned along a longitudinal direction, the outwardly facing protrusionsconfigured to interface with corresponding longitudinal grooves of theoverlay to provide for adjustment of the probe body along a longitudinaldirection. The probe holder can also include transversely outwardlyfacing hemispherical protrusions having a semi-circular cross-sectionaligned along a longitudinal direction, the outwardly facing protrusionsconfigured to interface with corresponding longitudinal v-grooves of theoverlay to provide for adjustment of the probe body along a longitudinaldirection. The probe holder can also include a retractable flapconfigured to hold the ultrasound probe in place upon the ultrasoundprobe engaging with the probe holder and release the ultrasound probeupon being actuated by a user. The probe holder can also include arotatable knob located within the central portion of the probe holderbody, the rotatable knob being configured to apply a force to theoverlay when engaging a relatively elevated portion of a disc below therotatable knob to provide an outwardly facing protrusion. The rotatableknob can be configured to decrease a clearance between outwardly facingprotrusions of the probe holder and corresponding longitudinal groovesof the overlay in response to a rotation in a first direction. Therotatable knob can be configured to increase a clearance betweenoutwardly facing protrusions of the probe holder and correspondinglongitudinal grooves of the overlay in response to further rotation inthe first direction. The rotatable knob can be configured to increase aclearance between outwardly facing protrusions of the probe holder andcorresponding longitudinal grooves of the overlay in response to afurther rotation in the first direction or a rotation in a seconddirection opposite to the first direction. The probe holder can alsoinclude a rotatable, longitudinally aligned member configured tolongitudinally translate the ultrasound probe with respect to theoverlay and to be user-accessed and user-controlled from within, acentral region of a radiation couch or overlay thereupon. The rotatable,longitudinally aligned member is located on a side opposite of theultrasound probe to provide for access to the rotatable, longitudinallyaligned member and is located to be user-accessed and user-controlledfrom within, a central region of a radiation couch or overlay thereupon.

In an aspect, the disclosure can feature a method for using a probeholder for positioning an ultrasound probe at a specified location alonga longitudinal translation path within a central region of a radiationcouch or overlay thereupon, the central region being located betweenlateral regions that are arranged to be underlying a patient's legs. Themethod can include user-accessing and user-controlling, from within thecentral region, a probe holder for translating the probe longitudinallytoward and away from a portion of the patient. The method can alsoinclude clamping, from within the central region, the probe holder at aspecified location along the translation path in the central region. Themethod can also include rotating an actuator on a clamp to increase africtional force associated with the probe holder. Translating the probelongitudinally can include using transversely outwardly facingprotrusions to interface with corresponding longitudinal grooves.Clamping can include reducing a clearance within a groove. The methodcan also include automatically engaging or retaining the probe uponinsertion onto the translation path and requiring user-activated releaseof the probe upon removal from the translation path. The clamping caninclude rotating a knob to engage a relatively elevated portion of adisc having a variable height. The method can also include unclamping,from within the central region, the probe holder, the unclampingcomprising rotating the knob to engage a relatively lower portion of thedisc having a variable height. The unclamping can include rotating theknob in an opposite direction as the rotating for clamping. The methodcan also include fine-adjusting a longitudinal position of the probeholder along the translation path using a separate actuation from agross-adjusting of the longitudinal position of the probe holder alongthe translation path. The fine-adjusting can be accessible from a sideof the probe holder configured to be inferior to the patient.

In an aspect, the disclosure can feature supports for a lower body of apatient. The supports can include a pair of separate knee supports, eachindividual knee support including a portion shaped to accommodate apatient's knee from behind the knee, the pair of knee supports beingshaped and arranged to provide a space therebetween that can accommodatean ultrasound probe holder. The supports can also include a pair of kneesupports having a recessed portion corresponding to a raised mountingportion of an overlay, wherein a recessed portion of each individualknee support includes indexed engagement features for engaging acorresponding mounting portion of the overlay. The supports can alsoinclude a pair of knee supports having a protruding portioncorresponding to a recessed portion of an overlay, wherein a protrudingportion of each individual knee support includes indexed engagementfeatures for engaging a corresponding recessed portion of the overlay.The space between the pair of knee supports can allow for access to apatient's perineum. The supports can also include a pair of separateankle supports including a portion shaped to accommodate a patient'sankles from behind and a lateral slide for engaging a correspondingfeature of an overlay for a radiation couch. The supports can alsoinclude a booster shaped to be inserted between an individual one of theknee supports and the overlay to provide an increased height of the kneesupport with respect to the overlay. The booster can be shaped to beinserted between an ankle support cushion and the overlay to provide anincreased height of the ankle support cushion with respect to theoverlay. The pair of ankle supports can include a recessed portion on abottom side of an individual one of the ankle supports to provideclearance for an ultrasound probe holder.

In an aspect, the disclosure can feature a method for supporting a lowerbody of a patient. The method can include supporting, on a first kneesupport on a radiation couch or an overlay thereupon, a first knee of apatient from behind the first knee. The method can also includesupporting, on a second knee support on the radiation couch or on theoverlay thereupon, a second knee of the patient from behind the secondknee. The method can also include providing access to a patient via aprobe holder in a central region formed by the first and second kneesupports being placed in lateral regions on opposing sides. The methodcan also include placing the first and second knee supports on theradiation couch or the overlay thereupon using an indexing engagementfeature of each individual knee support. The method can also includeproviding access to the patient's perineum in a space between the firstand second knee supports. The method can also include separatelysupporting, on an ankle support on a radiation couch or an overlaythereupon, an ankle of the patient from behind the ankle, and allowinglongitudinal adjustment of the ankle support along a longitudinal track.The method can also include inserting a booster between at least one ofthe first or second knee supports and the overlay to provide anincreased height of the at least one of the first or second knee supportwith respect to the overlay. The method can also include inserting abooster between the ankle support and the overlay to provide anincreased height of the ankle support with respect to the overlay. Anindividual instance of the booster can adapted to be used selectablywith the first or second knee supports and with the ankle support.

In an aspect, the disclosure can feature a method of supporting a lowerbody of a patient. The method can include supporting a patient's kneesusing a knee support shaped and arranged to provide a space therebetweenthat can accommodate an ultrasound probe holder. The method can alsoinclude indexing the knee support to a raised mounting portion of anoverlay using a recessed portion of the knee support. The method canalso include providing access to the patient's perineum via the spacebetween the knee support. The method can also include adjusting alongitudinal position of a pair of ankle supports in a longitudinaldirection along an exterior groove of an overlay. The method can alsoinclude inserting a booster between the knee supports and an overlay toprovide an increased height of the knee supports with respect to theoverlay. The method can also include inserting a booster between theankle supports and the overlay to provide an increased height of theankle supports with respect to the overlay.

In an aspect, the disclosure can feature a system for positioning anultrasound probe proximal to anatomy of a patient on a radiation couch.The system can include a substantially planar base including engagementfeatures to directly or indirectly index the substantially planar baseto the radiation couch and a centrally located guide extendinglongitudinally along a top side of the base. The system can also includea probe holder, configured to be coupled to, to translatelongitudinally, and to be user-accessed and user-controlled from within,a central region of the substantially planar base. The system can alsoinclude a clamp, configured to localize the probe holder at a specifiedlocation along a translation path in the central region of thesubstantially planar base. The system can also include leg supportsshaped to accommodate a patient's legs from behind, the pair of legsupports being shaped and arranged to provide a space therebetween thatcan accommodate an ultrasound probe holder. The system can also includean indexing bar for providing a transversely aligned interface betweenthe substantially planar base and the radiation couch, the indexing barincluding protrusions on a bottom side for engaging with slots in theradiation couch and protrusions on a top side for engaging with thesubstantially planar base. The centrally located guide can include apair of rails including respective longitudinal grooves centrally facingeach other and arranged to guide the probe holder during translationalmovement along a longitudinal axis of the base and the centrally locatedguide can include a pair of rails including respective longitudinalgrooves, outwardly facing away from each other and arranged to engage atleast one patient support cushion. The system can also include a pair ofankle supports including a portion shaped to accommodate the patient'sankles and latterly inwardly facing protrusions for contacting at leastone outwardly facing groove of the centrally located guide, the inwardlyfacing protrusions capable of allowing adjustment of a longitudinalposition of the pair of ankle supports. The radiation couch can includea scale capable of indexing the indexing bar and the substantiallyplanar base includes a scale capable of indexing the probe holder andankle supports. The system can also include a clamp located within ahollow central portion of the probe holder, the clamp being configuredto increase a frictional force between the probe holder and thesubstantially planar base. The system can also include a rotatable knoblocated within a central portion of the probe holder body, the rotatableknob being configured to apply a force to the substantially planar basewhen engaging a relatively elevated portion of a disc below therotatable knob to provide an outwardly facing protrusion.

In an aspect, the disclosure can feature a method of positioning anultrasound probe proximal to anatomy of a patient on a couch forradiotherapy. The method can include positioning an indexing bar on theradiation couch at a marked position of the couch. The method can alsoinclude positioning an overlay with respect to the indexing bar at afirst marked position of the overlay. The method can also includepositioning the patient on the couch and overlay. The method can alsoinclude attaching a pair of knee cushions to a raised portion of theoverlay. The method can also include adjusting a position of the overlayto position the overlay with respect to the indexing bar at a secondmarked position of the overlay. The method can also include coupling aprobe holder to a central guide region of the overlay. The method canalso include coupling an ultrasound probe to the probe holder in acentral guide region of the overlay. The method can also includeadjusting a position of a pair of ankle cushions to provide support tothe patient's ankles. The method can also include longitudinallyadjusting a position of the probe holder to bring an ultrasound probeinto proximity to a perineum of the patient. The method can also includerecording the marked position of the radiation couch and the markedposition of the overlay. The method can also include removing theoverlay and the indexing bar from the radiation couch. The method canalso include using the recorded marked positions to position theindexing bar and overlay. The method can also include accessing andcontrolling the probe holder from within a central region of theradiation couch to adjust a longitudinal position of the probe holder.The method can also include rotating an actuator located within acentral region of the probe holder to increase a frictional forcebetween outwardly facing protrusions of the probe holder andcorresponding longitudinal grooves of the overlay in response to arotation in a first direction. The method can also include rotating anactuator located within a central region of the probe holder to increasea frictional force associated with the probe holder. The method can alsoinclude individually adjusting the pair of knee cushions to providesupport to a back of the patient's knees. The method can also includeautomatically engaging or retaining the ultrasound probe upon insertiononto a translation path and requiring user-activated release of theultrasound probe upon removal from the translation path. The method canalso include guiding translational movement of the probe holder fromwithin the central guide region of the overlay using a longitudinalgroove along a longitudinal axis of the overlay. The method can alsoinclude engaging the pair of ankle cushions using respectivelongitudinal grooves of the overlay, outwardly facing away from eachother. The method can also include positioning the overlay using ahandle located at a first end of the overlay, and one or more glides,located on a bottom side of the overlay on an opposing second end of theoverlay; and then placing the overlay into engagement with one or moreof indexed engagement features.

The above overview is intended to provide an overview of subject matterof the present patent application. It is not intended to provide anexclusive or exhaustive explanation of the invention. The detaileddescription is included to provide further information about the presentpatent application.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numeralsdescribe substantially similar components throughout the several views.Like numerals having different letter suffixes represent differentinstances of substantially similar components. The drawings illustrategenerally, by way of example but not by way of limitation, variousembodiments discussed in the present document.

FIG. 1 illustrates an example of portions of a radiotherapy system,according to some embodiments of the present disclosure.

FIG. 2 illustrates an example of portions of radiation therapy systemthat can include radiation therapy output configured to provide atherapy beam.

FIGS. 3A and 3B illustrate an example of portions of an ultrasoundpositioning system.

FIG. 4 illustrates an example of a method of using an ultrasoundpositioning system.

FIGS. 5A and 5B illustrate an example of an overlay.

FIG. 6 illustrates an example of portions of method of using an overlay.

FIG. 7A illustrates an example of portions of an ultrasound probeholder.

FIGS. 7B and 7C illustrate an example of portions of a clampingmechanism in an ultrasound probe holder.

FIG. 8 illustrates an example of portions of a method of using anultrasound probe holder.

FIGS. 9A-9I illustrate examples of a patient support cushions.

FIG. 10 illustrates an example of a method of using one or more patientsupport cushions.

DETAILED DESCRIPTION

In certain radiation treatment systems, a patient can be positioned on asurface such as can be provided by radiation couch, and an ultrasoundprobe can be positioned with respect to anatomy of a patient, such as toacquire ultrasound images of the patient anatomy for treatment planningor during the radiation treatment of the patient. The ultrasound probemay have to be repositioned many times over the course of radiationtreatment planning or radiation treatment.

The present inventor has recognized, among other things, that theprocess of positioning an ultrasound probe can be greatly improved byproviding a radiation treatment system in which the ultrasound probe canbe indexed with respect to a radiation couch and additionally can becentrally accessed and positioned while a patient is on the radiationcouch, such as to improve the speed and accuracy at which the patientand ultrasound probe can be positioned, such as can improve patientworkflows (e.g., allow for each patient to be treated in less time andwith more accuracy). Accessing the ultrasound probe from just one sideof the radiation couch may be awkward or inefficient, while centralaccess from either side of the radiation couch can help provide improvedease-of-access and use, which can make a treatment planning session ortreatment procedure more efficient.

FIG. 1 illustrates an example of a radiotherapy system 100 for providingradiation therapy to a patient. The radiotherapy system 100 can includeor be coupled to an image processing device, 112. The image processingdevice 112 may be connected to one or more of a local or a wide areacommunications or other network 120. For example, the network 120 may beconnected to the Internet 122. The network 120 can connect the imageprocessing device 112 with one or more of a database 124, a hospitaldatabase 126, an oncology information system (OIS) 128, a radiationtherapy device 130, an image acquisition device 132, a display device134, or a user interface 136. The image processing device 112 can beconfigured to be used to generate one or more radiation therapytreatment plans 142 to be used by the radiation therapy device 130.

The image processing device 112 may include a memory device 116, aprocessor 114 circuit and a communication interface 118. The memorydevice 116 may store computer-executable instructions, such as anoperating system 143, one or more radiation therapy treatment plans 142(e.g., original treatment plans, adapted treatment plans, or the like),software programs 144 (e.g., artificial intelligence, deep learning,neural networks, radiotherapy treatment plan software), or any othercomputer-executable instructions to be executed by the processor 114. Inan embodiment, the software programs 144 may convert medical images ofone format (e.g., MRI) to another format (e.g., CT) such as by producingone or more synthetic images, such as a pseudo-CT image. For instance,the software programs 144 may include image processing programs such asto train a predictive model for converting a medial image 146 in onemodality (e.g., an MRI image) into a synthetic image of a differentmodality (e.g, a pseudo CT image); alternatively, the trained predictivemodel may convert a CT image into an MRI image. In another embodiment,the software programs 144 may register the patient image (e.g., a CTimage or an MRI image) with that patient's dose distribution (which canalso be represented as an image) so that corresponding image voxels anddose voxels are associated appropriately by the network. In yet anotherembodiment, the software programs 144 may substitute one or morefunctions of the patient images such as signed distance functions orprocessed versions of the images that emphasize some aspect of the imageinformation. Such functions may emphasize edges or differences in voxeltextures, or any other structural aspect useful to neural networklearning. In another embodiment, the software programs 144 maysubstitute one or more functions of the dose distribution that canemphasize some aspect of the dose information. Such functions mayemphasize steep gradients around the target, or any other structuralaspect useful to neural network learning. The memory device 116 maystore data, including medical images 146, patient data 145, and otherdata useful to create and implement a radiation therapy treatment plan142.

In addition to the memory 116 storing the software programs 144, it iscontemplated that software programs 144 may be stored on a removablecomputer medium, such as a hard drive, a computer disk, a CD-ROM, a DVD,a HD, a Blu-Ray DVD, USB flash drive, a SD card, a memory stick, or anyother suitable medium; and the software programs 144 when downloaded toimage processing device 112 may be executed by image processor 114.

The processor 114 may be communicatively coupled to the memory device116, and the processor 114 may be configured to execute computerexecutable instructions stored thereon. The processor 114 may send orreceive medical images 146 to memory 116. For example, the processor 114may receive medical images 146 from the image acquisition device 132 viathe communication interface 118 and network 120 to be stored in memory116. The processor 114 may also send medical images 146 stored in memory116 via the communication interface 118 to the network 120 be eitherstored in database 124 or the hospital database 126.

Further, the processor 114 may utilize software programs 144 (e.g., atreatment planning software) along with the medical images 146 andpatient data 145 to create the radiation therapy treatment plan 142.Medical images 146 may include information such as imaging dataassociated with a patient anatomical region, organ, or volume ofinterest segmentation data. Patient data 145 may include informationsuch as (1) functional organ modeling data (e.g., serial versus parallelorgans, appropriate dose response models, etc.); (2) radiation dosagedata (e.g., dose-volume histogram (DVH) information; or (3) otherclinical information about the patient and course of treatment (e.g.,other surgeries, chemotherapy, previous radiotherapy, etc.).

In addition, the processor 114 may utilize software programs to generateintermediate data such as updated parameters to be used, for example, bya neural network model; or generate intermediate 2D or 3D images, whichmay then subsequently be stored in memory 116. The processor 114 maysubsequently then transmit the executable radiation therapy treatmentplan 142 via the communication interface 118 to the network 120 to theradiation therapy device 130, where the radiation therapy plan will beused to treat a patient with radiation. In addition, the processor 114may execute software programs 144 to implement functions such as imageconversion, image segmentation, deep learning, neural networks, andartificial intelligence. For instance, the processor 114 may executesoftware programs 144 that train or contour a medical image; suchsoftware 144 when executed may train a boundary detector, or utilize ashape dictionary.

The processor 114 may be a processing device, and may include one ormore general-purpose processing devices such as a microprocessor, acentral processing unit (CPU), a graphics processing unit (GPU), anaccelerated processing unit (APU), or the like. More particularly, theprocessor 114 may be a complex instruction set computing (CISC)microprocessor, a reduced instruction set computing (RISC)microprocessor, a very long instruction Word (VLIW) microprocessor, aprocessor implementing other instruction sets, or processorsimplementing a combination of instruction sets. The processor 114 mayalso be implemented by one or more special-purpose processing devicessuch as an application specific integrated circuit (ASIC), a fieldprogrammable gate array (FPGA), a digital signal processor (DSP), aSystem on a Chip (SoC), or the like. As would be appreciated by thoseskilled in the art, in some embodiments, the processor 114 may be aspecial-purpose processor, rather than a general-purpose processor. Theprocessor 114 may include one or more known processing devices, such asa microprocessor from the Pentium™, Core™, Xeon™, or Itanium® familymanufactured by Intel™, the Turion™, Athlon™, Sempron™, Opteron™, FX™,Phenom™ family manufactured by AMD™, or any of various processorsmanufactured by Sun Microsystems. The processor 114 may also includegraphical processing units such as a GPU from the GeForcek®, QuadrA®,Tesla® family manufactured by Nvidia™, GMA, Iris™ family manufactured byIntel™, or the Radeon™ family manufactured by AMD™. The processor 114may also include accelerated processing units such as the Xeon Phi™family manufactured by Intel™. The disclosed embodiments are not limitedto any type of processor(s) otherwise configured to meet the computingdemands of identifying, analyzing, maintaining, generating, and/orproviding large amounts of data or manipulating such data to perform themethods disclosed herein. In addition, the term “processor” may includemore than one processor, for example, a multi-core circuit design or aplurality of processors each having a multi-core design. The processor114 can execute sequences of computer program instructions, stored inmemory 116, to perform various operations, processes, methods that willbe explained in greater detail below.

The memory device 116 can store medical images 146. In some embodiments,the medical images 146 may include one or more MRI image (e.g., 2D MRI,3D MRI, 2D streaming MRI, 4D MRI, 4D volumetric MRI, 4D cine MRI, etc.),functional MRI images (e.g., fMRI, DCE-MRI, diffusion MRI). ComputedTomography (CT) images (e.g., 2D CT, Cone beam CT, 3D CT, 4D CT),ultrasound images (e.g., 2D ultrasound, 3D ultrasound, 4D ultrasound),Positron Emission Tomography (PET) images. X-ray images, fluoroscopicimages, radiotherapy portal images, Single-Photo Emission ComputedTomography (SPECT) images, computer generated synthetic images (e.g.,pseudo-CT images) and the like. Further, the medical images 146 may alsoinclude medical image data, for instance, training images, and groundtruth images, contoured images, and dose images. In an embodiment, themedical images 146 may be received from the image acquisition device132. Accordingly, image acquisition device 132 may include a MRI imagingdevice, a CT imaging device, a PET imaging device, an ultrasound imagingdevice, a fluoroscopic device, a SPECT imaging device, an integratedLinear Accelerator and MRI imaging device, or other medical imagingdevices for obtaining the medical images of the patient. The medicalimages 146 may be received and stored in any type of data or any type offormat that the image processing device 112 may use to performoperations consistent with the disclosed embodiments. The memory device116 may be a non-transitory computer-readable medium, such as aread-only memory (ROM), a phase-change random access memory (PRAM), astatic random access memory (SRAM), a flash memory, a random accessmemory (RAM), a dynamic random access memory (DRAM) such as synchronousDRAM (SDRAM), an electrically erasable programmable read-only memory(EEPROM), a static memory (e.g., flash memory, flash disk, static randomaccess memory) as well as other types of random access memories, acache, a register, a compact disc read-only memory (CD-ROM), a digitalversatile disc (DVD) or other optical storage, a cassette tape, othermagnetic storage device, or any other non-transitory medium that may beused to store information including image, data, or computer executableinstructions (e.g., stored in any format) capable of being accessed bythe processor 114, or any other type of computer device. The computerprogram instructions can be accessed by the processor 114, read from theROM, or any other suitable memory location, and loaded into the RAM forexecution by the processor 114. For example, the memory 116 may storeone or more software applications. Software applications stored in thememory 116 may include, for example, an operating system 143 for commoncomputer systems as well as for software-controlled devices. Further,the memory 116 may store an entire software application, or only a partof a software application, that are executable by the processor 114. Forexample, the memory device 116 may store one or more radiation therapytreatment plans 142.

The image processing device 112 can communicate with the network 120 viathe communication interface 118, which can be communicatively coupled tothe processor 114 and the memory 116. The Communication interface 118may provide communication connections between the image processingdevice 112 and radiotherapy system 100 components (e.g., permitting theexchange of data with external devices). For instance, the communicationinterface 118 may in some embodiments have appropriate interfacingcircuitry to connect to the user interface 136, which may be a hardwarekeyboard, a keypad, or a touch screen through which a user may inputinformation into radiotherapy system 100.

Communication interface 118 may include, for example, a network adaptor,a cable connector, a serial connector, a USB connector, a parallelconnector, a high-speed data transmission adaptor (e.g., such as fiber,USB 3.0, thunderbolt, and the like), a wireless network adaptor (e.g.,such as a WiFi adaptor), a telecommunication adaptor (e.g., 3G, 4G/LTEand the like), and the like. Communication interface 118 may include oneor more digital and/or analog communication devices that permit imageprocessing device 112 to communicate with other machines and devices,such as remotely located components, via the network 120.

The network 120 may provide the functionality of a local area network(LAN), a wireless network, a cloud computing environment (e.g., softwareas a service, platform as a service, infrastructure as a service, etc.),a client-server, a wide area network (WAN), and the like. For example,network 120 may be a LAN or a WAN that may include other systems S1(138), S2 (140), and S3 (141). Systems S1, S2, and S3 may be identicalto image processing device 112 or may be different systems. In someembodiments, one or more of systems in network 120 may form adistributed computing/simulation environment that collaborativelyperforms the embodiments described herein. In some embodiments, one ormore systems S1, S2, and S3 may include a CT scanner that obtain CTimages (e.g., medical images 146). In addition, network 120 may beconnected to internet 122 to communicate with servers and clients thatreside remotely on the internet.

Therefore, network 120 can allow data transmission between the imageprocessing device 112 and a number of various other systems and devices,such as the OIS 128, the radiation therapy device 130, and the imageacquisition device 132. Further, data generated by the OIS 128 and/orthe image acquisition device 132 may be stored in the memory 116, thedatabase 124, and/or the hospital database 126. The data may betransmitted/received via network 120, through communication interface118 such as to be accessed by the processor 114, as required.

The image processing device 112 may communicate with database 124through network 120 to send/receive a plurality of various types of datastored on database 124. For example, database 124 may include machinedata that is information associated with a radiation therapy device 130,image acquisition device 132, or other machines relevant toradiotherapy. Machine data information may include radiation beam size,arc placement, beam on and off time duration, machine parameters,segments, multi-leaf collimator (MLC) configuration, gantry speed, MRIpulse sequence, and the like. Database 124 may be a storage device andmay be equipped with appropriate database administration softwareprograms. One skilled in the art would appreciate that database 124 mayinclude a plurality of devices located either in a central or adistributed manner.

In some embodiments, database 124 may include a processor-readablestorage medium (not shown). While the processor-readable storage mediumin an embodiment may be a single medium, the term “processor-readablestorage medium” should be taken to include a single medium or multiplemedia (e.g., a centralized or distributed database, and/or associatedcaches and servers) that store the one or more sets of computerexecutable instructions or data. The term “processor-readable storagemedium” shall also be taken to include any medium that is capable ofstoring or encoding a set of instructions for execution by a processorand that cause the processor to perform any one or more of themethodologies of the present disclosure. The term “processor readablestorage medium” shall accordingly be taken to include, but not belimited to, solid-state memories, optical and magnetic media. Forexample, the processor readable storage medium can be one or morevolatile, non-transitory, or non-volatile tangible computer-readablemedia.

Image processor 114 may communicate with database 124 to read imagesinto memory 116 or store images from memory 116 to database 124. Forexample, the database 124 may be configured to store a plurality ofimages (e.g., 3D MRI, 4D MRI, 2D MRI slice images. CT images, 2DFluoroscopy images, X-ray images, raw data from MR scans or CT scans,Digital Imaging and Communications in Medicine (DIMCOM) data, etc.) thatthe database 124 received from image acquisition device 132. Database124 may store data to be used by the image processor 114 when executingsoftware program 144, or when creating radiation therapy treatment plans142. Database 124 may store the data produced by the trained neuralnetwork including the network parameters constituting the model learnedby the network and the resulting predicted data. The image processingdevice 112 may receive the imaging data 146 (e.g., 2D MRI slice images,CT images, 2D Fluoroscopy images. X-ray images, 3DMRI images, 4D MRIimages, etc.) either from the database 124, the radiation therapy device130 (e.g., a MRI-Linac), and or the image acquisition device 132 togenerate a treatment plan 142.

In an embodiment, the radiotherapy system 100 can include an imageacquisition device 132 that can acquire medical images (e.g., MagneticResonance Imaging (MRI) images, 3D MRI, 2D streaming MRI, 4D volumetricMRI, Computed Tomography (CT) images, Cone-Beam CT, Positron EmissionTomography (PET) images, functional MRI images (e.g, fMRI, DCE-MRI anddiffusion MRI), X-ray images, fluoroscopic image, ultrasound images,radiotherapy portal images, single-photo emission computed tomography(SPECT) images, and the like) of the patient. Image acquisition device132 may, for example, be an MRI imaging device, a CT imaging device, aPET imaging device, an ultrasound device, a fluoroscopic device, a SPECTimaging device, or any other suitable medical imaging device forobtaining one or more medical images of the patient. Images acquired bythe imaging acquisition device 132 can be stored within database 124 aseither imaging data and/or test data. By way of example, the imagesacquired by the imaging acquisition device 132 can be also stored by theimage processing device 112, as medical image data 146 in memory 116.

In an embodiment, for example, the image acquisition device 132 may beintegrated with the radiation therapy device 130 as a single apparatus(e.g., a MRI device combined with a linear accelerator, also referred toas an “MRI-Linac.” Such an MRI-Linac can be used, for example, todetermine a location of a target organ or a target tumor in the patient,so as to direct radiation therapy accurately according to the radiationtherapy treatment plan 142 to a predetermined target.

The image acquisition device 132 can be configured to acquire one ormore images of the patient's anatomy for a region of interest (e.g., atarget organ, a target tumor or both). Each image, typically a 2D imageor slice, can include one or more parameters (e.g., a 2D slicethickness, an orientation, and a location, etc.). In an embodiment, theimage acquisition device 132 can acquire a 2D slice in any orientation.For example, an orientation of the 2D slice can include a sagittalorientation, a coronal orientation, or an axial orientation. Theprocessor 114 can adjust one or more parameters, such as the thicknessand/or orientation of the 2D slice, to include the target organ and/ortarget tumor. In an embodiment, 2D slices can be determined frominformation such as a 3D MRI volume. Such 2D slices can be acquired bythe image acquisition device 132 in “near real-time” while a patient isundergoing radiation therapy treatment, for example, when using theradiation therapy device 130. “Near real-time” meaning acquiring thedata in at least milliseconds or less.

The image processing device 112 may generate and store radiation therapytreatment plans 142 for one or more patients. The radiation therapytreatment plans 142 may provide information about a particular radiationdose to be applied to each patient. The radiation therapy treatmentplans 142 may also include other radiotherapy information, such as beamangles, dose-histogram-volume information, the number of radiation beamsto be used during therapy, the dose per beam, or the like.

The image processor 114 may generate the radiation therapy treatmentplan 142 by using software programs 144 such as treatment planningsoftware, such as Monaco®, manufactured by Elekta AB of Stockholm,Sweden. In order to generate the radiation therapy treatment plans 142,the image processor 114 may communicate with the image acquisitiondevice 132 (e.g., a CT device, a MRI device, a PET device, an X-raydevice, an ultrasound device, etc.) to access images of the patient andto delineate a target, such as a tumor. In some embodiments, thedelineation of one or more organs at risk (OARs), such as healthy tissuesurrounding the tumor or in close proximity to the tumor may berequired. Therefore, segmentation of the OAR may be performed when theOAR is close to the target tumor. In addition, if the target tumor isclose to the OAR (e.g., prostate in near proximity to the bladder andrectum), then by segmenting the OAR from the tumor, the radiotherapysystem 100 may study the dose distribution not only in the target, butalso in the OAR.

In order to delineate a target organ or a target tumor from the OAR,medical images, such as MRI images, CT images, PET images, fMRI images,X-ray images, ultrasound images, radiotherapy portal images, SPECTimages and the like, of the patient undergoing radiotherapy may beobtained non-invasively by the image acquisition device 132 to revealthe internal structure of a body part. Based on the information from themedical images, a 3D structure of the relevant anatomical portion may beobtained. In addition, during a treatment planning process, manyparameters may be taken into consideration to achieve a balance betweenefficient treatment of the target tumor (e.g., such that the targettumor receives enough radiation dose for an effective therapy) and lowirradiation of the OAR(s) (e.g., the OAR(s) receives as low a radiationdose as possible). Other parameters that may be considered include thelocation of the target organ and the target tumor, the location of theOAR, and the movement of the target in relation to the OAR. For example,the 3D structure may be obtained by contouring the target or contouringthe OAR within each 2D layer or slice of an MRI or CT image andcombining the contour of each 2D layer or slice. The contour may begenerated manually (e.g., by a physician, dosimetrist, or health careworker using a program such as MONACO™ manufactured by Elekta AB ofStockholm, Sweden) or automatically (e.g., using a program such as theAtlas-based auto-segmentation software, ABAS™, manufactured by Elekta ABof Stockholm. Sweden). In certain embodiments, the 3D structure of atarget tumor or an OAR may be generated automatically by the treatmentplanning software.

After the target tumor and the OAR(s) have been located and delineated,a dosimetrist, physician or healthcare worker may determine a dose ofradiation to be applied to the target tumor, as well as any maximumamounts of dose that may be received by the OAR proximate to the tumor(e.g., left and right parotid, optic nerves, eyes, lens, inner ears,spinal cord, brain stem, and the like). After the radiation dose isdetermined for each anatomical structure (e.g., target tumor, OAR), aprocess known as inverse planning may be performed to determine one ormore treatment plan parameters that would achieve the desired radiationdose distribution. Examples of treatment plan parameters include volumedelineation parameters (e.g., which define target volumes, contoursensitive structures, etc.), margins around the target tumor and OARs,beam angle selection, collimator settings, and beam-on times. During theinverse-planning process, the physician may define dose constraintparameters that set bounds on how much radiation an OAR may receive(e.g., defining full dose to the tumor target and zero dose to any OAR;defining 95% of dose to the target tumor; defining that the spinal cord,brain stein, and optic structures receive ≤45 Gy, ≤55 Gy and <54 Gy,respectively). The result of inverse planning may constitute a radiationtherapy treatment plan 142 that may be stored in memory 116 or database124. Some of these treatment parameters may be correlated. For example,tuning one parameter (e.g., weights for different objectives, such asincreasing the dose to the target tumor) in an attempt to change thetreatment plan may affect at least one other parameter, which in turnmay result in the development of a different treatment plan. Thus, theimage processing device 112 can generate a tailored radiation therapytreatment plan 142 having these parameters in order for the radiationtherapy device 130 to provide radiotherapy treatment to the patient.

In addition, the radiotherapy system 100 may include a display device134 and a user interface 136. The display device 134 may include one ormore display screens that display medical images, interface information,treatment planning parameters (e.g., contours, dosages, beam angles,etc.) treatment plans, a target, localizing a target and/or tracking atarget, or any related information to the user. The user interface 136may be a keyboard, a keypad, a touch screen or any type of device that auser may input information to radiotherapy system 100. Alternatively,the display device 134 and the user interface 136 may be integrated intoa device such as a tablet computer, e.g., Apple iPad®, Lenovo Thinkpad®,Samsung Galaxy®, etc.

Furthermore, any and all components of the radiotherapy system 100 maybe implemented as a virtual machine (e.g., VMWare, Hyper-V, and thelike). For instance, a virtual machine can be software that functions ashardware. Therefore, a virtual machine can include at least one or morevirtual processors, one or more virtual memories, and one or morevirtual communication interfaces that together function as hardware. Forexample, the image processing device 112, the OIS 128, the imageacquisition device 132 could be implemented as a virtual machine. Giventhe processing power, memory, and computational capability available,the entire radiotherapy system 100 could be implemented as a virtualmachine.

FIG. 2 illustrates an example of portions of radiation therapy device202 that may include a radiation source, such as an X-ray source or alinear accelerator, a couch 216, an imaging detector 214, and aradiation therapy output 204. The radiation therapy device 202 may beconfigured to emit a radiation beam 208 to provide therapy to a patient.The radiation therapy output 204 can include one or more attenuators orcollimators, such as a multi-leaf collimator (MLC).

In FIG. 2, a patient can be positioned in a region 212, supported by thetreatment couch 216 to receive a radiation therapy dose according to aradiation therapy treatment plan. The radiation therapy output 204 canbe mounted or attached to a gantry 206 or other mechanical support. Oneor more chassis motors (not shown) may rotate the gantry 206 and theradiation therapy output 204 around couch 216 when the couch 216 isinserted into or located within the treatment area. In an embodiment,gantry 206 may be continuously rotatable around couch 216 when the couch216 is inserted into or located within the treatment area. In anotherembodiment, gantry 206 may rotate to a predetermined or specifiedposition when the couch 216 is inserted into the treatment area. Forexample, the gantry 206 can be configured to rotate the therapy output204 around an axis (“A”) that can point in a longitudinal direction.Both the couch 216 and the radiation therapy output 204 can beindependently moveable to other positions around the patient, such asmoveable in transverse direction (“T”), moveable in a lateral direction(“L”), or as rotation about one or more other axes, such as rotationabout a transverse axis (indicated as “R”). A controller communicativelyconnected to one or more actuators (not shown) may control the couch 216movements or rotations in order to properly position the patient in orout of the radiation beam 208 according to a radiation therapy treatmentplan. As both the couch 216 and the gantry 206 are independentlymoveable from one another in multiple degrees of freedom, which allowsthe patient to be positioned such that the radiation beam 208 preciselycan target the tumor.

The coordinate system (including axes A, 7, and L) shown in FIG. 2 canhave an origin located at an isocenter 210. The isocenter can be definedas a location where the central axis of the radiation therapy beam 208intersects the origin of a coordinate axis, such as to deliver aprescribed radiation dose to a location on or within a patient.Alternatively, the isocenter 210 can be defined as a location where thecentral axis of the radiation therapy beam 208 intersects the patientfor various rotational positions of the radiation therapy output 204 aspositioned by the gantry 206 around the axis A.

Gantry 206 may also have an attached imaging detector 214. The imagingdetector 214 preferably located opposite to the radiation source 204,and in an embodiment, the imaging detector 214 can be located within afield of the therapy beam 208.

The imaging detector 214 can be mounted on the gantry 206 preferablyopposite the radiation therapy output 204, such as to maintain alignmentwith the therapy beam 208. The imaging detector 214 rotating about therotational axis as the gantry 206 rotates. In an embodiment, the imagingdetector 214 can be a flat panel detector (e.g., a direct detector or ascintillator detector). In this manner, the imaging detector 214 can beused to monitor the therapy beam 208 or the imaging detector 214 can beused for imaging the patient's anatomy, such as portal imaging. Thecontrol circuitry of radiotherapy device 202 may be integrated withinsystem 100 or remote from it.

In an illustrative embodiment, one or more of the couch 216, the therapyoutput 204, or the gantry 206 can be automatically positioned, and thetherapy output 204 can establish the therapy beam 208 according to aspecified dose for a particular therapy delivery instance. A sequence oftherapy deliveries can be specified according to a radiation therapytreatment plan, such as using one or more different orientations orlocations of the gantry 206, couch 216, or therapy output 204. Thetherapy deliveries can occur sequentially, but can intersect in adesired therapy locus on or within the patient, such as at the isocenter210. A prescribed cumulative dose of radiation therapy can thereby bedelivered to the therapy locus while damage to tissue nearby the therapylocus can be reduced or avoided.

FIG. 2 generally illustrates an embodiment of a radiation therapy deviceconfigured to provide radiotherapy treatment to a patient, including aconfiguration where a radiation therapy output can be rotated around acentral axis (e.g., an axis “A”). Other radiation therapy outputconfigurations can be used. For example, a radiation therapy output canbe mounted to a robotic arm or manipulator having multiple degrees offreedom. In yet another embodiment, the therapy output can be fixed,such as located in a region laterally separated from the patient, and aplatform supporting the patient can be used to align a radiation therapyisocenter with a specified target locus within the patient. In anotherembodiment, a radiation therapy device can be a combination of a linearaccelerator and an image acquisition device. In some embodiments, theimage acquisition device may be an MRI, an X-ray, a CT, a CBCT, a spiralCT, a PET, a SPECT, an optical tomography, a fluorescence imaging,ultrasound imaging, or radiotherapy portal imaging device, etc., aswould be recognized by one of ordinary skill in the art.

FIG. 3A illustrates an example of portions of an ultrasound positioningsystem 300. The ultrasound positioning system 300 can include an overlay304, an ultrasound probe holder 308, knee cushions 312, and anklecushions 316. One or more portions of the ultrasound positioning system300 can be directly or indirectly attached to a radiation couch 216,such as via an indexing bar 320 and the overlay 304. The radiation couch216 can include markings along a longitudinal direction, such as can beused to mark a position of the indexing bar 320, such as with respect tothe radiation couch 216. The indexing bar 320 can include reciprocalengagement features or other like mating features, such as on a top andbottom side of the indexing bar 320. The mating features on the bottomside of the indexing bar 320 can be coupled to or engaged withcorresponding mating features of the radiation couch 216, such as toselectively position the indexing bar 320 at a marked position withrespect to the radiation couch 216. The overlay 304 can include markingsand corresponding reciprocal engagement features or other like matingfeatures along a longitudinal direction of the overlay 304. The overlay304 can be positioned with respect to and engaged or attached to theindexing bar, such as at a desired marked position of the overlay 304.This can include coupling or engaging mating features on a top side ofthe indexing bar 320 to desired locations of corresponding matingfeatures of the overlay 304. Additionally, the locations of the heels ofa patient can be determined using the markings (e.g., ruled markings) ofthe overlay 304, such as when the patient's ankles are resting flat onthe overlay 304. The ultrasound probe holder 308 can be inserted into acentral guide region of the overlay 304, such as from a distal edge ofthe overlay 304 that is located in a direction that is away from thepatient's torso. The ultrasound probe holder 308 can include a clamp,which can be used to determine whether the ultrasound probe holder 308can freely move along a longitudinal direction within the central guideregion of the overlay 304, or whether the ultrasound probe holder 308can be fixed at a particular location along the longitudinal direction.Each of the knee cushions 312 can include a mating feature that can beengaged or coupled to a corresponding mating feature of the overlay 304,such as to fix a position of the knee cushion 312 with respect to theoverlay 304. The ankle cushions 316 can be movably coupled to a centralguide region of the overlay 304 and can move freely along a longitudinaldirection of the overlay 304. An ultrasound probe 324 can be insertedinto the ultrasound probe holder 308, such as illustrated in FIG. 3B. Aposition of the ultrasound probe 324 can then be adjusted, using theultrasound probe holder 308, such as until the ultrasound probe 324 isbrought against or into proximity with a portion of anatomy of a patient328.

FIG. 4 illustrates an example of portions of a method 400 of usingportions of an ultrasound positioning system, such as ultrasoundpositioning system 300. An indexing bar, such as indexing bar 320, canbe positioned at a selected position (e.g., of multiple availableindexed positions) on a radiation couch or other platform forradiotherapy, such as couch 216 (step 404). The indexing bar 320 can beselectively placed at a desired marked position of the couch 216. Anoverlay, such as overlay 304, can be positioned with respect to theindexing bar 320 (step 408). The overlay 304 can be positioned to engagethe indexing bar 320 at a marked position of the overlay 304. A patient,such as patient 328, can be positioned overlay 304 on the couch 216(step 412). In an example, one or more permanent or temporary markings(e.g., tattoos) on the patient can be used to position the patient, suchas with respect to the couch 216 and overlay 304. Knee cushions, such asknee cushions 312 can be coupled at a fixed position with respect to theoverlay 304 (step 416) A pair of ankle cushions, such as ankle cushions316 can be adjustably located at a desired position along a longitudinaldirection, such as to provide support for the patient's ankles (step420). A position of the overlay 304 can be adjusted with respect to thecouch 216 or the patient 328, such as by adjusting a marked position ofthe overlay 304 with respect to the indexing bar 320 (step 424). Theposition of the overlay 304 can be adjusted to provide comfort to thepatient 328, such as based on contemporaneous or previous feedback fromthe patient 328. The marked position of the overlay 304 can be recordedand used in a subsequent radiation therapy session, such as to allow forconvenient positioning of the overlay 304 without requiring furtheradjustments. An ultrasound probe, such as the ultrasound probe 324 canbe coupled to the ultrasound probe holder 308 in a central guide regionof the overlay 304 (step 428). The ultrasound probe holder 308 can bemanually translated (e.g, pushed or pulled by a clinician) in alongitudinal direction towards patient anatomy (e.g., a perineum of thepatient) until the ultrasound probe 324 contacts the patient (step 432).The ultrasound probe holder 308 can then be clamped in position. Further(e.g., fine) adjustments of the longitudinal position of the ultrasoundprobe holder 308 can then be made via a centrally accessible actuator ofthe ultrasound probe holder 308 (step 436). The further adjustments ofthe longitudinal position can be used to adjust a pressure exerted onthe patient by the ultrasound probe 324. Such fine adjustment can helpbring the ultrasound probe close enough against the patient to obtain agood quality image, while limiting the amount of discomfort felt by thepatient by the probe pressing against the patient.

FIG. 5A illustrates an example of an overlay, such as the overlay 304.The overlay 304 can include indexed engagement features 532 such as forcoupling the overlay to an indexing bar, such as the indexing bar 320.Each of the engagement features 532 can correspond to at least onecorresponding marking 528 of the overlay 304. For example, thecorresponding markings can convey information about the spacing betweenadjacent engagement features 532, or about a cumulative distance from areference marking and corresponding engagement feature 532. Theengagement features 532 can engage directly to a couch, such as couch216, or indirectly to the couch 216, such as via the indexing bar 320.The overlay 304 can include a central guide region 504, such asindicated by the dashed lines in FIG. 5A. The central guide region 504can include one or more (e.g., a pair) of guide rails 508. Each of theguide rails 508 can include a V-shaped or other interior (e.g.,inward-facing) groove 512 and V-shaped or other exterior (e.g.,laterally outward facing) groove 510. The interior grooves 512 can faceeach other. An ultrasound probe holder, such as the ultrasound probeholder 324 can engage with and can be guided in a longitudinal directionby the interior grooves 512 and a channel therebetween. The overlay 304can also include a retention feature such as a spring-biased,resiliently-biased, or other flap 511, such as can be configured toallow the probe holder 324 to be inserted into the channel between theinterior grooves 512. Inserting the probe holder 324 into the grooves512 can automatically push the flap out of the way upons such insertion.The flap 511 can then automatically spring outward when the probe holder324 has been moved along the grooves 512, such as to help prevent theprobe holder from being removed from the channel in the absence ofmanual actuation of the flap 511. Then, when release of the probe holder324 is desired, the user can depress or otherwise manually actuate theflap 511. The exterior grooves 510 can face outwardly away from eachother. Ankle cushions, such as ankle cushions 316 can engage with andcan be guided in a longitudinal direction by the exterior grooves 510.The overlay 304 can also include one or more mating features 516 (e.g.,one or more protrusions or depressions) that can be coupled to one ormore corresponding features of knee cushions, such as on the undersidesof the knee cushions 312. The knee cushions can be indexed to the matingfeatures 516. The overlay 304 can also include at least one glide 536 ona bottom side of the overlay 304 as illustrated in FIG. 5B which shows aside view of the overlay 304. In an example, the glide can be formedfrom a material including polyoxymethylene (POM), also known as acetal.An individual glide 536 can include a protrusion from the bottom of theoverlay 304 and can be made of a hard plastic or other material having arelatively low coefficient of friction with the couch 216. The at leastone glide 536 can allow the overlay 304 to easily slide back and forthon the couch 216. The overlay 304 can also include at least one stickybump 540. An individual sticky bump 540 can include a protrusion fromthe bottom of the overlay 304 and can be made of a soft plastic or othermaterial having a relatively large coefficient of friction with thecouch 216. In an example, the sticky bump can be formed from a materialincluding polyurethane (PUR) or synthetic rubber. The at least onesticky bump 540 can be configured to provide resistance to slidingmovement of the overlay 304 when the at least one sticky bump 540 is incontact with the couch 216. The overlay 304 can also include a handle524 that can be used to elevate an inferior end (e.g., end of overlayfurther from the patient's head) of the overlay 304 where the handle 524is located. When the handle 524 is elevated, the at least one stickybump 540 can be brought out of contact with the couch 216, while the atleast one glide 536 can remain in contact with the couch 216. Then, withonly the at least one glide 536 in contact with the couch 216, theoverlay 304 can be repositioned. The handle 524 can then be lowered tobring the at least one sticky bump 540 back into contact with the couch216.

FIG. 6 illustrates a method 600 of using an overlay, such as the overlay304. The overlay can be positioned at an indexed position on a couch,such as couch 216 (step 604). The overlay 304 can guide translationalmovement of an ultrasound probe holder, such as the ultrasound probeholder 308, along a longitudinal axis of the overlay from within acentral region of the overlay (step 608). A longitudinal groove, such asone or both of the interior grooves 512 can be used to guide thetranslational movement of the ultrasound probe holder. One or morepatient support cushions can be engaged using one or more longitudinalgrooves, such as the exterior grooves 510 of the overlay (step 612). Oneor more patient support cushions can also be engaged to one or moremating features (e.g., protrusions or depressions) on a top surface ofthe overlay 304. The overlay can be initially positioned orre-positioned without indexed engagement using a handle and one or moreglides, such as the handle 524 the at least one glide 536. After beingpositioned, the overlay can be placed into engagement with one or moreindexed engagement features, such as one or more mating features of anindexing bar, such as the indexing bar 320.

FIG. 7A illustrates an example of an ultrasound probe holder, such asthe ultrasound probe holder 308. The ultrasound probe holder 308 caninclude a clamp 708, a fine adjustment mechanism 704, a retractable flap712, a first body portion 716 a, a second body portion 716 b, andprotrusions 720. The retractable flap 712 can lock an ultrasound probe,such as the ultrasound probe 324 into position when the ultrasound probeis coupled to the second body portion 716 b. The retractable flap 712can be manually actuated to release the ultrasound probe 324 from thesecond body 716 b. The protrusions 720 can include outwardly facingprotrusions aligned along a longitudinal direction. The protrusions 720can interface with corresponding longitudinal grooves of an overlay,such as the interior grooves 512, such as to allow the ultrasound probeholder 308 to be translated within a central guide region of the overlay304 in a longitudinal direction. In an example, the protrusions 720 canhave a semi-circular cross section and the interior grooves 512 can havea v-shaped cross section that can accommodate the protrusions 720. Theclamp 708 can be centrally located within the ultrasound probe holderand can include a rotatable knob 710, a disc 724, and a plate 728 suchas illustrated in FIGS. 7B-7C. One or more springs and associatedmechanical linkage can be used to maintain contact between the disc 724and the rotatable knob 710, even as the rotatable knob 710 is rotatedbetween different positions. At least one roller 709 can be attached toan underside of the knob 710. The at least one roller 709 can slidealong the disc 724 when the knob 710 is rotated. The disc can include atleast one notched portion 726 that can be shaped to accommodate the atleast one roller 709. A position of the knob 710 can be locked (e.g.,held in place in the absence of manual rotation of the knob 710) whenthe at least one roller 709 is resting in the at least one notchedportion 726.

In an example, the clamp 708 can include two rollers 709) that can bediametrically opposing to one another. The disc 724 can include fournotches 726 spaced at ninety degree intervals along the disc 724. Afirst pair of the four notches 726 can be spaced by one hundred andeighty degrees and can correspond to a first height. A second pair ofthe four notches 726 can be spaced by one hundred and eighty degrees andcan correspond to a second height. When the two rollers 709 engage withthe first pair of the four notches 726 (a first knob position), such ascan be illustrated in FIG. 7B, the disc 728 can extend from a bottom ofthe ultrasound probe holder 308 by a first distance d₂, such as canprovide a clamping force to lock the ultrasound probe holder 308 inplace with respect to the overlay 304. The clamping force can beprovided by a frictional force between the disc 728 and the overlay 304.The disc 728 can include a relatively sticky substance (e.g.,polyurethane (PUR) or synthetic rubber) on a surface to provideincreased friction between the disc 728 and the overlay 304. Additionalclamping force can be provided by the protrusions 720 being brought intocloser contact with the interior grooves 512 when the disc 728 extendsfrom the bottom of the ultrasound probe holder 308 by the first distanced₂. When the two rollers 709 engage with the second pair of the fournotches 726 (a second knob position), such as can be illustrated in FIG.7C, the disc 728 can extend from a bottom of the ultrasound probe holder308 by a second distance d₂ smaller than the first distance d₁, such ascan reduce a clamping force to allow the ultrasound probe holder 308 tomove freely in a longitudinal direction with respect to the overlay 304.Additionally, a clearance between the protrusions 720 and the interiorgrooves 512 can be increased when the two rollers 709 engage with thesecond pair of the four notches 726. Thus, by toggling between the firstand second knob positions, the ultrasound probe holder 308 can beclamped or unclamped to the overlay 304.

The fine adjustment mechanism 704 can include a rotatable knob that canbe centrally accessed when the patient is resting on the overlay 304 andradiation couch 216 as illustrated in FIG. 3B (e.g., the fine adjustmentmechanism can be accessed from a central region of the overlay 304, andneed not be accessed laterally from the side). The rotatable knob can beactuated, such as to adjust a distance between the first body portion716 a and the second body portion 716 b. In an example where anultrasound probe, such as the ultrasound probe 324 can be mounted to thesecond body portion 716 b, a position of the ultrasound probe can beadjusted with respect to the overlay 304 by using actuating therotatable knob of the fine adjustment mechanism 704. The rotatable knobcan be turned in a first direction, such as to cause the first bodyportion 716 a to move away from the second body portion 716 b, such asto increase a distance d₁ between the first body portion 716 a and 716b. The rotatable knob can also be turned in a second direction differentfrom the first direction, such as to cause the first body portion 716 ato move toward the second body portion 716 b, such as to decrease adistance d₁ between the first body portion 716 a and 716 b The rotatableknob can adjust the distance d₁ between the first body portion 716 a and716 b independent of whether the ultrasound probe holder 308 is clampedto the overlay 304.

FIG. 8 illustrates an exemplary method 800 of using an ultrasound probeholder. The probe holder can be inserted into a central guide region ofan overlay, such as the overlay 304 (step 804). The ultrasound probeholder can be automatically engaged to the overlay upon insertion onto alongitudinal path in a central guide region of the overlay 304. Theprobe holder can be user-accessed and user-controlled from within acentral region to translate the probe longitudinally toward or away frompatient anatomy (step 808). The probe holder can be clamped at aspecified location along the longitudinal translation path (step 812).The clamping can reduce a clearance within a groove, such as an interiorgroove 512. An actuator on the clamp can be rotated to increase africtional force associated with the probe holder. The actuator can berotated in a first direction to provide clamping of the ultrasound probeholder 308 to the overlay 304. The actuator can then be further rotatedin the first direction or rotated in a second direction opposite to thefirst direction to reduce clamping of the ultrasound probe holder 308 tothe overlay 304. An ultrasound probe, such as the ultrasound probe 324can then be attached to the ultrasound probe holder. The ultrasoundprobe can be attached a portion of the ultrasound probe holder and canbe locked into place by a retractable flap. The ultrasound probe 324 canbe further translated along a longitudinal direction, such as by using acentrally located and centrally accessible fine adjustment mechanism,such as the fine adjustment mechanism 704 (step 816).

FIGS. 9A and 9B illustrate examples of a patient support cushions, suchas ankle cushions 316 and knee support cushions 312. The knee supportcushions 312 can include portions shaped to accommodate a patient's kneefrom behind the knee. Additionally, the knee support cushions 312 can beshaped and arranged to provide a space therebetween that can accommodatean ultrasound probe holder, such as ultrasound probe holder 308. Thus,the ultrasound probe holder 308 can freely slide between the kneesupport cushions 312 in a central guide region of the overlay 304. Asillustrated in FIG. 9C, the knee support cushions can include a recessedmounting portion that includes indexed engagement features for engaginga corresponding raised mounting portion of an overlay, such as overlay304. The knee support cushions can also include a raised mountingportion that includes indexed engagement features for engaging acorresponding recessed mounting portion of an overlay, such as overlay304. The knee support cushions can be indexed to the overlay in alongitudinal and/or lateral direction. The space provided between theknee support cushions can allow for access to a patient's perineum. Abooster can be shaped to be inserted between an individual one of theknee support cushions and the overlay, such as to adjust a height of theindividual knee support cushion. The ankle cushions 316 can include alateral slide for engaging a corresponding feature of an overlay, suchas the overlay 304. A bottom side of the ankle cushions can include arecessed portion 317 that can provide a space to accommodate anultrasound probe holder, such as the ultrasound probe holder 308. Therecessed portion 317 can include slides that can engage with at leastone exterior groove, such as exterior groove 510 of the overlay. Theankle cushions 316 can then be translated in a longitudinal directionalong the overlay 304. The recessed portion 317 can have a height d3that can accommodate the height of the ultrasound probe holder, suchthat the ultrasound probe holder can slide underneath the anklecushions, or vice versa. In an example, the recessed portions can have aheight d3 that can accommodate only a portion of the height of theultrasound probe holder, such that only a portion of the ultrasoundprobe holder can slide underneath the ankle cushions. For example, theheight d3 may not be large enough to accommodate a knob of theultrasound probe holder, such that the knob of the ultrasound probeholder acts as a stop to limit relative longitudinal translation betweenthe knee cushions and the ultrasound probe holder. Additionally, each ofthe individual knee support cushions 312 can include a handle 913 on anunderside of the individual knee support cushion 312 as shown in FIGS.9D and 9E. The handle 913 can include a protrusion shaped to be grippedby a human hand. The handle 913 can be shaped such as to provide ease ofgrabbing the knee support cushion 312 with a single hand. This can beuseful for a therapist when setting up the patient on the radiationcouch. For example, one hand can be used to lift the patient's leg whilethe other hand can be used to insert the knee support cushion 312. Asimilar handle 915 can be included on an underside of a booster as shownin FIGS. 9F and 9G. The handle 915 can include recessed portions thatcan be gripped by fingers of a clinician or therapist. The variousrecessed portions can be spaced and arranged to accommodate differenthand sizes. A similar handle 917 can be included on an underside of theankle cushions 316 as illustrated in FIGS. 9H and 9I. The handle 917 caninclude recessed portions that can be gripped by fingers of a clinicianor therapist. The various recessed portions can be spaced and arrangedto accommodate different hand sizes.

FIG. 10 illustrates a method of using patient support cushions, such asknee cushions 312 and ankle cushions 316. A first knee cushion 312 canbe used to support a patient's first knee from behind the knee (step1004). A second knee cushion 312 can be used to support a patient'ssecond knee from behind the knee (step 1008). The first and second kneecushions can provide access to a patient via a probe holder in a centralregion formed by the first and second knee cushions being placed inlateral regions on opposing sides. Each of the individual knee cushionscan be indexed to an overlay, such as the overlay 304. An ankle cushioncan be used to support the patient's ankles from behind the ankles (step1012). The ankle cushion can be translated in a longitudinal directionalong a longitudinal track. A booster can be provided between anindividual one of the knee cushions and the overlay, such as to adjust aheight of the individual knee cushion. The booster can also be usedbetween the ankle cushion and the overlay, such as to adjust a height ofthe ankle cushion.

Additional Notes

The above detailed description includes references to the accompanyingdrawings, which form a part of the detailed description. The drawingsshow, by way of illustration but not by way of limitation, specificembodiments in which the invention can be practiced. These embodimentsare also referred to herein as “examples.” Such examples can includeelements in addition to those shown or described. However, the presentinventors also contemplate examples in which only those elements shownor described are provided. Moreover, the present inventors alsocontemplate examples using any combination or permutation of thoseelements shown or described (or one or more aspects thereof), eitherwith respect to a particular example (or one or more aspects thereof),or with respect to other examples (or one or more aspects thereof) shownor described herein.

All publications, patents, and patent documents referred to in thisdocument are incorporated by reference herein in their entirety, asthough individually incorporated by reference. In the event ofinconsistent usages between this document and those documents soincorporated by reference, the usage in the incorporated reference(s)should be considered supplementary to that of this document; forirreconcilable inconsistencies, the usage in this document controls.

In this document, the terms “a,” “an,” “the,” and “said” are used whenintroducing elements of aspects of the invention or in the embodimentsthereof, as is common in patent documents, to include one or more thanone or more of the elements, independent of any other instances orusages of “at least one” or “one or more.” In this document, the term“or” is used to refer to a nonexclusive or, such that “A or B” includes“A but not B,” “B but not A,” and “A and B,” unless otherwise indicated.

In the appended claims, the terms “including” and “in which” are used asthe plain-English equivalents of the respective terms “comprising” and“wherein.” Also, in the following claims, the terms “comprising,”“including,” and “having” are intended to be open-ended to mean thatthere may be additional elements other than the listed elements, suchthat after such a term (e.g., comprising, including, having) in a claimare still deemed to fall within the scope of that claim. Moreover, inthe following claims, the terms “first,” “second,” and “third,” etc.,are used merely as labels, and are not intended to impose numericalrequirements on their objects.

Embodiments of the invention may be implemented with computer-executableinstructions. The computer-executable instructions (e.g., software code)may be organized into one or more computer-executable components ormodules. Aspects of the invention may be implemented with any number andorganization of such components or modules. For example, aspects of theinvention are not limited to the specific computer-executableinstructions or the specific components or modules illustrated in thefigures and described herein. Other embodiments of the invention mayinclude different computer-executable instructions or components havingmore or less functionality than illustrated and described herein.

Method examples (e.g., operations and functions) described herein can bemachine or computer-implemented at least in part (e.g., implemented assoftware code or instructions). Some examples can include acomputer-readable medium or machine-readable medium encoded withinstructions operable to configure an electronic device to performmethods as described in the above examples. An implementation of suchmethods can include software code, such as microcode, assembly languagecode, a higher-level language code, or the like (e.g., “source code”).Such software code can include computer readable instructions forperforming various methods (e.g., “object” or “executable code”). Thesoftware code may form portions of computer program products. Softwareimplementations of the embodiments described herein may be provided viaan article of manufacture with the code or instructions stored thereon,or via a method of operating a communication interface to send data viaa communication interface (e.g., wirelessly, over the internet, viasatellite communications, and the like).

Further, the software code may be tangibly stored on one or morevolatile or non-volatile computer-readable storage media duringexecution or at other times. These computer-readable storage media mayinclude any mechanism that stores information in a form accessible by amachine (e.g., computing device, electronic system, and the like), suchas, but are not limited to, floppy disks, hard disks, removable magneticdisks, any form of magnetic disk storage media. CDROMS, magnetic-opticaldisks, removable optical disks (e.g., compact disks and digital videodisks), flash memory devices, magnetic cassettes, memory cards or sticks(e.g., secure digital cards), random access memories (RAMs) (e.g., CMOSRAM and the like), recordable/non-recordable media (e.g., read onlymemories (ROMs)), EPROMS, EEPROMS, or any type of media suitable forstoring electronic instructions, and the like. Such computer readablestorage medium coupled to a computer system bus to be accessible by theprocessor and other parts of the OIS.

In an embodiment the computer-readable storage medium may have encoded adata structure for a treatment planning, wherein the treatment plan maybe adaptive. The data structure for the computer-readable storage mediummay be at least one of a Digital Imaging and Communications in Medicine(DICOM) format, an extended DICOM format, a XML format, and the like.DICOM is an international communications standard that defines theformat used to transfer medical image-related data between various typesof medical equipment. DICOM RT refers to the communication standardsthat are specific to radiation therapy.

In various embodiments of the invention, the method of creating acomponent or module can be implemented in software, hardware, or acombination thereof. The methods provided by various embodiments of thepresent invention, for example, can be implemented in software by usingstandard programming languages such as, for example, C, C++, Java,Python, and the like; and combinations thereof. As used herein, theterms “software” and “firmware” are interchangeable, and include anycomputer program stored in memory for execution by a computer.

A communication interface includes any mechanism that interfaces to anyof a hardwired, wireless, optical, and the like, medium to communicateto another device, such as a memory bus interface, a processor businterface, an Internet connection, a disk controller, and the like. Thecommunication interface can be configured by providing configurationparameters and/or sending signals to prepare the communication interfaceto provide a data signal describing the software content. Thecommunication interface can be accessed via one or more commands orsignals sent to the communication interface.

The present invention also relates to a system for performing theoperations herein. This system may be specially constructed for therequired purposes, or it may comprise a general purpose computerselectively activated or reconfigured by a computer program stored inthe computer. The order of execution or performance of the operations inembodiments of the invention illustrated and described herein is notessential, unless otherwise specified. That is, the operations may beperformed in any order, unless otherwise specified, and embodiments ofthe invention may include additional or fewer operations than thosedisclosed herein. For example, it is contemplated that executing orperforming a particular operation before, contemporaneously with, orafter another operation is within the scope of aspects of the invention.

In view of the above, it will be seen that the several objects of theinvention are achieved and other advantageous results attained. Havingdescribed aspects of the invention in detail, it will be apparent thatmodifications and variations are possible without departing from thescope of aspects of the invention as defined in the appended claims. Asvarious changes could be made in the above constructions, products, andmethods without departing from the scope of aspects of the invention, itis intended that all matter contained in the above description and shownin the accompanying drawings shall be interpreted as illustrative andnot in a limiting sense.

The above description is intended to be illustrative, and notrestrictive. For example, the above-described examples (or one or moreaspects thereof) may be used in combination with each other. Inaddition, many modifications may be made to adapt a particular situationor material to the teachings of the invention without departing from itsscope. While the dimensions, types of materials and coatings describedherein are intended to define the parameters of the invention, they areby no means limiting and are exemplar) embodiments. Many otherembodiments will be apparent to those of skill in the art upon reviewingthe above description. The scope of the invention should, therefore, bedetermined with reference to the appended claims, along with the fullscope of equivalents to which such claims are entitled.

Also, in the above Detailed Description, various features may be groupedtogether to streamline the disclosure. This should not be interpreted asintending that an unclaimed disclosed feature is essential to any claim.Rather, inventive subject matter may lie in less than all features of aparticular disclosed embodiment. Thus, the following claims are herebyincorporated into the Detailed Description, with each claim standing onits own as a separate embodiment. The scope of the invention should bedetermined with reference to the appended claims, along with the fullscope of equivalents to which such claims are entitled. Further, thelimitations of the following claims are not written inmeans-plus-function format and are not intended to be interpreted basedon 35 U.S.C. § 112, sixth paragraph, unless and until such claimlimitations expressly use the phrase “means for” followed by a statementof function void of further structure.

The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allowthe reader to quickly ascertain the nature of the technical disclosure.It is submitted with the understanding that it will not be used tointerpret or limit the scope or meaning of the claims.

What is claimed is:
 1. A system for positioning an ultrasound probeproximal to anatomy of a patient on a radiation couch, the systemcomprising: a substantially planar base including engagement features todirectly or indirectly index the substantially planar base to theradiation couch and a centrally located guide extending longitudinallyalong a top side of the base; a probe holder, configured to be coupledto, to translate longitudinally, and to be user-accessed anduser-controlled from within, a central region of the substantiallyplanar base; a clamp, configured to localize the probe holder at aspecified location along a translation path in the central region of thesubstantially planar base; and leg supports shaped to accommodate apatient's legs from behind, the pair of leg supports being shaped andarranged to provide a space therebetween that can accommodate anultrasound probe holder.
 2. The system of claim 1 comprising an indexingbar for providing a transversely aligned interface between thesubstantially planar base and the radiation couch, the indexing barincluding protrusions on a bottom side for engaging with slots in theradiation couch and protrusions on a top side for engaging with thesubstantially planar base.
 3. The system of claim 2 wherein thecentrally located guide comprises a pair of rails including respectivelongitudinal grooves centrally facing each other and arranged to guidethe probe holder during translational movement along a longitudinal axisof the base and wherein the centrally located guide comprises a pair ofrails including respective longitudinal grooves, outwardly facing awayfrom each other and arranged to engage at least one patient supportcushion.
 4. The system of claim 3 comprising a pair of ankle supportsincluding a portion shaped to accommodate the patient's ankles andlatterly inwardly facing protrusions for contacting at least oneoutwardly facing groove of the centrally located guide, the inwardlyfacing protrusions capable of allowing adjustment of a longitudinalposition of the pair of ankle supports.
 5. The system of claim 4 whereinthe radiation couch includes a scale capable of indexing the indexingbar and the substantially planar base includes a scale capable ofindexing the probe holder and ankle supports.
 6. The system of claim 1comprising a clamp located within a hollow central portion of the probeholder, the clamp being configured to increase a frictional forcebetween the probe holder and the substantially planar base.
 7. Thesystem of claim 6 comprising a rotatable knob located within a centralportion of the probe holder body, the rotatable knob being configured toapply a force to the substantially planar base when engaging arelatively elevated portion of a disc below the rotatable knob toprovide an outwardly facing protrusion.
 8. A method of positioning anultrasound probe proximal to anatomy of a patient on a couch forradiotherapy, the method comprising: positioning an indexing bar on theradiation couch at a marked position of the couch; positioning anoverlay with respect to the indexing bar at a first marked position ofthe overlay; positioning the patient on the couch and overlay; attachinga pair of knee cushions to a raised portion of the overlay; adjusting aposition of the overlay to position the overlay with respect to theindexing bar at a second marked position of the overlay; coupling aprobe holder to a central guide region of the overlay; coupling anultrasound probe to the probe holder in a central guide region of theoverlay; adjusting a position of a pair of ankle cushions to providesupport to the patient's ankles; and longitudinally adjusting a positionof the probe holder to bring an ultrasound probe into proximity to aperineum of the patient.
 9. The method of claim 8 comprising: recordingthe marked position of the radiation couch and the marked position ofthe overlay; removing the overlay and the indexing bar from theradiation couch; and using the recorded marked positions to position theindexing bar and overlay.
 10. The method of claim 8 comprising accessingand controlling the probe holder from within a central region of theradiation couch to adjust a longitudinal position of the probe holder.11. The method of claim 8 comprising rotating an actuator located withina central region of the probe holder to increase a frictional forcebetween outwardly facing protrusions of the probe holder andcorresponding longitudinal grooves of the overlay in response to arotation in a first direction.
 12. The method of claim 8 comprisingrotating an actuator located within a central region of the probe holderto increase a frictional force associated with the probe holder.
 13. Themethod of claim 8 comprising individually adjusting the pair of kneecushions to provide support to a back of the patient's knees.
 14. Themethod of claim 8 comprising automatically engaging or retaining theultrasound probe upon insertion onto a translation path and requiringuser-activated release of the ultrasound probe upon removal from thetranslation path.
 15. The method of claim 8 comprising guidingtranslational movement of the probe holder from within the central guideregion of the overlay using a longitudinal groove along a longitudinalaxis of the overlay.
 16. The method of claim 8 comprising engaging thepair of ankle cushions using respective longitudinal grooves of theoverlay, outwardly facing away from each other.
 17. The method of claim8 comprising positioning the overlay using a handle located at a firstend of the overlay, and one or more glides, located on a bottom side ofthe overlay on an opposing second end of the overlay; and then placingthe overlay into engagement with one or more of indexed engagementfeatures.